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Bigger Picture: ‘One size does not always fit all’

Mandy Rumley-Buss on why emergency departments shouldn't push all their advanced nurse practitioners into the newly credentialled advanced clinical practitioner role

Mandy Rumley-Buss on why emergency departments shouldn't push all their advanced nurse practitioners into the newly credentialled advanced clinical practitioner role


Picture: iStock

There now exists a nationwide standard and credentialing process that establishes clarity around the role of the emergency care advanced clinical practitioner (ACP).

This is because of the Royal College of Emergency Medicine’s (RCEM) Emergency Care ACP Curriculum and Assessment published last year. It has been a long time coming and should be welcomed.

Unlike in the case of the advanced nurse practitioner (ANP), the ACP role is clearly defined and credentialled through the RCEM, whereas the ANP role is not recognised by the National Midwifery Council although the emergency nurse practitioner (ENP) and ANP roles are recognised by the RCN.

‘It will take a minimum of three years to credential as an advanced care practitioner’

But let us not assume this process to ACP will be a swift one that all ANPs will all be able to undertake and fast track through.

To credential as an ACP, it will take a minimum of three years – based on whole time equivalence – and candidates must:

  • Have at least five years post-registration experience, with a minimum of three years emergency care.
  • Be registered with their professional body.

The standard of practice they are expected to reach at the end of their training is to emergency medicine level.

Wide range of pathologies

Emergency care ACPs will be able to look after patients with a wide range of pathologies, from life-threatening to self-limiting – and make autonomous decisions about admission and discharge of all emergency care patients.

From this, it is apparent that the ACP is not merely a step up from emergency or advanced nurse practitioner in majors, but a new, innovative role.

Those succeeding will be part of the medical, rather than the nursing, rota. That is not to say that many ANPs will not continue to evolve and develop, but not all will want – or be able to – complete the credentialing required.

‘We need to ensure that our ANPs value the work that they do – and the level of expertise they have – and not throw the baby out with the bath water’

What then will become of nursing in the emergency department?

Before we rush to push our ANPs into the ACP role – which is already happening in some areas – we need to think about the implications.

I fully endorse the new role, but also see the need for a multidisciplinary team of nurses, doctors, therapists and emergency care ACPs in emergency departments.

We need to ensure that our ANPs value the work that they do – and the level of expertise they have – and not, as we often do in nursing, throw the baby out with the bath water.

Backbone of care

ANPs have developed their role as specialists in minors as ENPs and many are developing expertise in majors in some pathways; they provide the backbone of care in minors across many parts of the UK.

In pushing them into the ACP role we must be clear with them about what the expectations are, about the rigour of the process and allow them time for development and supervision.

We also need to consider the consequences to the department if all we do is move our senior experienced nurse clinicians into this new role.

Some advanced nurse practitioners are already training towards, or want to become, an ACP, but it is also OK to want to continue working in roles supporting patients in all areas of the department.

One size does not always fit all.


About the author

Mandy Rumley-Buss is a steering committee member of the RCN Emergency Care Association and works independently as a nurse consultant and nurse practitioner in urgent care. She is also an associate of the Acute Frailty Network

 

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